Needle or Laser Acupuncture Do Not Improve Chronic Knee Pain in Patients with Knee Osteoarthritis

EBM Focus - Volume 9, Issue 41

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Reference: JAMA 2014 Oct 1;312(13):1313 (level 1 [likely reliable] evidence)

Acupuncture has been advocated for management of various painful conditions. However, high quality evidence supporting its use in patients with chronic knee pain has been lacking. A guideline from the American Academy of Orthopaedic Surgeons (AAOS) states that acupuncture cannot be recommended in patients with symptomatic osteoarthritis of the knee, due to lack of efficacy (AAOS 2013 May 18 PDF). Similarly, a guideline from the American College of Rheumatology (ACR) recommends traditional Chinese acupuncture only for patients with chronic moderate to severe pain who are candidates for total knee arthroplasty but are unwilling to have a procedure, have comorbid conditions, or are taking concomitant medication that contraindicates surgery (Arthritis Care Res (Hoboken) 2012 Apr;64(4):465-4 full-text). A recent randomized trial compared 2 forms of acupuncture (needle or laser) vs. sham acupuncture or no acupuncture in 282 patients ≥ 50 years old with chronic knee pain.

The trial enrolled patients who had knee pain for > 3 months, knee pain on most days with severity score ≥ 4 on numeric rating scale (range 0-10), and morning stiffness < 30 minutes, which is consistent with a clinical diagnosis of osteoarthritis. Patients received the intervention 1-2 times weekly for a total of 12 weeks. Comparing needle or laser acupuncture vs. sham at 12 weeks, there were no significant differences in knee pain, pain upon walking or standing, physical function, quality of life, or mental or physical health. These findings were consistent when assessed at 1 year.

The term “acupuncture” may refer to several different types of interventions, making it difficult to make a general conclusion about its efficacy in patients with degenerative joint disease of the knee. The findings of this new high-quality trial are consistent with another high-quality trial that also found no significant improvement in pain with traditional Chinese acupuncture vs. a sham acupuncture control (Arthritis Care Res (Hoboken) 2010 Sep;62(9):1229 full-text). In addition, a Cochrane review identified 16 trials evaluating patients with osteoarthritis (12 of which included only patients with knee osteoarthritis), and found that clinically significant improvement in pain and function with acupuncture only occurred in comparison to wait-list control, suggesting a placebo effect (Cochrane Database Syst Rev 2010 Jan 20;(1):CD001977). Based on the evidence to date, neither needle nor laser acupuncture appear effective for reducing chronic knee pain in patients with knee osteoarthritis.

For more information, see the Degenerative joint disease of the knee topic in DynaMed.